myasthenia gravis

1. By
Ms. Snehal Patil

3. Neuro transmission:

4. Definition :
 It is a chronic autoimmune neuromuscular disease
characterized by varying degree of weakness of
skeletal muscles of the body.
It is purely a motor disorder with no effects on
sensation and co-ordination.

5. Etiology :
 Genetic
 Abnormality of thymus gland
 Thymic hyperplasia
 Women at earlier age (20-40 years)
 Men at older age (60-70 years)

6. Classification :

7. Pathophysiology :

9. Ocular symptoms:
Ptosis Diplopia

10.  Nystagmus
 Dysarthia
 Weakness of muscles of face and throat

11. Bland facial expression Dysphonia

12. Intercostal muscle
weakness
Generalized weakness

13. Diagnostic Test :
 Anticholinesterase test :
normal value – 0.0 to 0.25 nmol/L
 Endrophonium chloride test:
endrophonium chloride (tensilon) 2mg to 10 mg
intravenously
 Repetative nerve stimulation test
 MRI for thymus gland enlargement

14. Medical management :
 Pharmacological therapy:
 Pyridostigmine bromide (anticholinesterase
medication)
 Immunosuppresive therapy
 Cytotoxic medications
 Azathioprine {T lymphocyte inhibitor}
 IVIG (Intravenous immune globulin)

15. Plasmapheresis:

16. Surgical Management :
 Thymectomy

17. Nursing management :
 Assessment – neurological examination
- extent of respiratory involvement
 Assistance in activities of daily living
 Nutrition through eternal route
 Aspiration precautions
 Skin care
 Effective method of communication

18. Nursing diagnosis :
 Ineffective breathing pattern related to respiratory
muscle weakness
 Ineffective airway clearance related to tracheal
secretions
 Impaired physical mobility related to weakness of
voluntary muscle
 Imbalanced nutrition less than body requirement
related to dysphagia, intubation or muscle paralysis
 Risk for aspiration related to weakness of bulbar
muscle

19.  Self care deficit related to muscle weakness
 Risk for infection related to immunosupressive status
or multiple invasive lines